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Hypotonic-Hyporesponsive Episodes Following Pertussis Vaccination

A Cause for Concern?

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Abstract

Vaccine safety has become a major community concern and of particular importance for parents, vaccine recipients and vaccine providers. A hypotonic-hyporesponsive episode (HHE) is a sudden and unexpected episode of loss of tone, unresponsiveness and colour change which uncommonly affects infants and children after vaccination. Although any vaccine may be associated with this adverse event, HHE usually follows administration of a pertussis containing vaccine. There has been renewed interest in this adverse event in the light of community concerns regarding vaccine safety. The focus of this interest has been to formulate an acceptable case definition, to document possible risk factors and to better define the outcome of HHE. In addition, studies have documented the outcome of revaccination of children who have had an HHE. Although much remains to be learnt about HHE it would appear that there are no long-term sequelae and that children who have had an HHE can be revaccinated. Parents should be provided with the available information such that they can make an assessment of the risks and benefits of pertussis vaccination. The benefits of pertussis vaccination still outweigh the risk and universal childhood pertussis vaccination should continue to be advocated.

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References

  1. Chen RT. Vaccine risk: real, perceived and unkown. Vaccine 1999; 17Suppl. 3: S41–6

    Article  PubMed  Google Scholar 

  2. Gangarosa EJ, Galazka AM, Wolfe CR, et al. Impact of anti-vaccine movements on pertussis control: the untold story. Lancet 1998; 351: 356–61

    Article  PubMed  CAS  Google Scholar 

  3. Institute of Medicine. Evidence concerning pertussis vaccines and central nervous system disorders including infantile spasms, hypsarrythmia, aseptic meningitis and encephalopathy. In: Howson CP, Howe CJ, Ffineberg HV, editors. Adverse effects of pertussis and rubella vaccines. Washington, DC: National Academy Press, 1991: 65–124

  4. Cody CL, Baraff LJ, Cherry JD, et al. Nature and rates of adverse reactions associated with DTP and DT immunizations in infants and children. Pediatrics 1981; 68(5): 650–60

    PubMed  CAS  Google Scholar 

  5. Braun MM, Terracciano G, Salive ME, et al. Report of a US public health service workshop on hypotonic-hyporesponsive episode (HHE) after pertussis immunization. Pediatrics 1998; 102(5): E52

    Article  PubMed  CAS  Google Scholar 

  6. Heijbel H, Ciofi degli Atti MC, Harzer E, et al. Hypotonic hyporesponsive episodes in eight pertussis vaccine studies. Dev Biol Stand 1997; 89: 101–3

    PubMed  CAS  Google Scholar 

  7. Schmitt HJ, Schuind A, Knuf M, et al. Clinical experience of a tricomponent acellular pertussis vaccine combined with diphtheria and tetanus toxoids for primary vaccination in 22,505 infants. J Pediatr 1996; 129(5): 695–701

    Article  PubMed  CAS  Google Scholar 

  8. Strom J. Further experience of reactions especially of a cerebral nature in conjunction with triple vaccination. BMJ 1967; 4: 320–3

    Article  PubMed  CAS  Google Scholar 

  9. Rosenthal S, Chen RT, Hadler S. The safety of acellular pertussis vaccine vs whole cell pertussis vaccine. Arch Pediatr Adolesc Med 1996; 150: 457–60

    Article  PubMed  CAS  Google Scholar 

  10. Gold MS, Kempe A, Osbourn M. A comparison of serious adverse reactions to whole cell and acellular pertussis vaccines in South Australia. Med J Aust 1999; 171(6): 331–2

    PubMed  CAS  Google Scholar 

  11. Miller E. Overview of recent trials of acellular pertussis vaccine. Biologicals 1999; 27: 79–86

    Article  PubMed  CAS  Google Scholar 

  12. Gold R, Scheifele D, Halperin S, et al. Hypotonic-hyporesponsive episodes in children hospitalized at 10 Canadian Pediatric Tertiary-Care Centres, 1991-1994. Can Commun Dis Rep 1997; 23(10): 73–6

    PubMed  CAS  Google Scholar 

  13. Sauer L. Whooping cough: a study in immunisation. American Medical Association Journal 1933; 100: 239–41

    Article  Google Scholar 

  14. Blumberg DA, Morgan CA, Lewis K, et al. An ongoing surveillance study of persistent crying and hypotonic-hyporesponsive episodes following routine DTP immunization: a preliminary report. Tokai J Exp Clin Med 1988; 131: 133–6

    Google Scholar 

  15. Munoz JJ, Arai H, Bergman RK, et al. Biological activities of crystalliane pertussisigen from Bordatella pertussis. Infect Immun 1981; 33: 820–6

    PubMed  CAS  Google Scholar 

  16. Blumberg DA, Mink CM, Lewis K, et al. Pathophysiology of reactions associated with pertussis vaccine. Devlop Biol Standard 1991; 73: 289–95

    CAS  Google Scholar 

  17. Baraff LJ, Manclark CR, Cherry JD, et al. Analyses of adverse reactions to diphtheria and tetanus toxoids and pertussis vaccine by vaccine lot, endotoxin content, pertussis vaccine potency and percentage of mouse weight gain. Pediatr Infect Dis J 1989; 8(8): 502–7

    Article  PubMed  CAS  Google Scholar 

  18. Blumberg DA, Lewis K, Mink CM, et al. Severe reactions associated with diphtheria-tetanus-pertussis vaccine: detailed study of children with seizures, hypotonic-hyporesponsive episodes, high fevers, and persistent crying. Pediatrics 1993. 91(6): 1158–65

    PubMed  CAS  Google Scholar 

  19. Du Vernoy TS, Braun MM. Hypotonic-hyporesponsive episodes reported to the vaccine adverse event reporting system (VAERS), 1996-1998. Pediatrics 2000; 106(4): E52

    Article  Google Scholar 

  20. Goodwin H, Nash M, Gold M, et al. Vaccination of children following a previous hypotonic-hyporesponsive episode. J Paediatr Child Health 1999; 35(6): 549–52

    Article  PubMed  CAS  Google Scholar 

  21. Baraff LJ, Shields WD, Beckwith L, et al. Infants and children with convulsions and hypotonic-hyporesponsive episodes following diphtheria-tetanus-pertussis immunization: follow-up evaluation. Pediatrics 1988; 81(6): 789–94

    PubMed  CAS  Google Scholar 

  22. Vermeer-de Bondt P, Labadie J, Rumke HC. Rate of recurrent collapse after vacination with whole cell pertussis vaccine: follow-up study. BMJ 1998; 316: 902–3

    Article  PubMed  CAS  Google Scholar 

  23. Gold M, Goodwin H, Botham S, et al. Revaccination of 421 children with a past history of an adverse vaccine reaction in a special immunisation service. Arch Dis Child 2000; 83: 128–31

    Article  PubMed  CAS  Google Scholar 

  24. Tozzi AE, Atti ML, Salmaso S, et al. Repeat whole cell vaccinations should be avoided after hypotonic-hyporesponsive episodes [letter]. BMJ 1998; 317(7158): 604

    Article  PubMed  CAS  Google Scholar 

  25. Andrews RM, Kempe AE, Sinn KK, et al. Vaccinating children with a history of serious reactions after vaccination or of egg allergy. Med J Aust 1988; 168(10): 491–4

    Google Scholar 

  26. Miller E. Collapse reactions after whole cell pertussis vaccination: pertussis remains a bigger risk than collapse after vaccination [editorial]. BMJ 1998; 316: 876

    Article  PubMed  CAS  Google Scholar 

  27. Ramsay M. Time to review policy on contraindications to vaccination. Lancet 2000; 356: 1459–60

    Article  PubMed  CAS  Google Scholar 

  28. The Australian College of Paediatrics Policy Statement. Contraindications to immunization against pertussis. J Paediatr Child Health 1994; 30: 310–11

    Google Scholar 

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Acknowledgements

The author has received no funding nor has any conflicts of interest related to the contents of this manuscript.

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  1. University Department of Paediatrics, and Immunisation Coordination Unit, Women’s and Children’s Hospital, 75 King William Road, North Adelaide, SA 5000, Australia

    Michael S. Gold

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  1. Michael S. Gold
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Correspondence to Michael S. Gold.

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Gold, M.S. Hypotonic-Hyporesponsive Episodes Following Pertussis Vaccination. Drug-Safety 25, 85–90 (2002). https://doi.org/10.2165/00002018-200225020-00003

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